The project goal is the evaluation and treatment of hyperparathyroidism. Patients with initial, persistent, or recurrent hyperparathyroidism are referred for evaluation and treatment. Hereditary hyperparathyroidism in particular is under investigation in the hopes of delineating hereditary molecular abnormalities in glandular regulation, as exemplified in the multiple endocrine neoplasia type 1 syndrome and hyperparathyroidism-jaw tumor syndrome. Evaluation ranges from epidemiologic studies of families to in-house clinical studies of patients and to in vitro analyses of excised tissue. Techniques currently being employed and improved include immunoassay of parathyroid hormone, ultrasonography, (reoperative and intra operative), technetium sestamibi scanning, magnetic resonance imaging, CAT scanning, PET scanning, selective arteriograpy, and selective venous sampling for parathyroid hormone, parathyroid gland cryopreservation and autotransplantation, and transcatheter parathyroid gland infarction. In vitro evaluation of parathyroid and other endocrine tissue involves tissue culture, chemistry and determination of lineage with DNA and RNA probes, utility of MEN1, CASR, and HRPT2 gene sequence testing and genetic conseling is studied in selected cases.